Dental MythBuster #4 – Dentists Still Use Novocaine

Dental MythBuster #4 – Dentists still use novocaine

There are some dental myths I hear quite frequently in my dental office in Orange, CT. The novocaine myth is one of the most common. Invariably, as I am talking about a procedure with my patient in the chair, he/she will say something to the effect of:

“So you are going to give me a shot of novocaine, right?”

I usually do not correct the patient, unless he/she works in the medical or pharmaceutical field. If I were to answer the question, I would say:

“No, I am not going to give you a shot of novocaine. Dentists stopped injecting novocaine over 30 years ago. We use local anesthetics that are more effective and have less potential for allergic reactions now.”

History of Local Anesthetics in Dentistry

Cocaine as a local anesthetic

Local anesthetics have been used in dentistry for over 100 years. The first widely used local anesthetic was actually cocaine. Cocaine was first used in a dental procedure in 1884. Prior to that, many other techniques were used, with the most common being the consumption of large quantities of alcohol before a dental procedure. Cocaine was certainly more effective than no local anesthetic (or drunkenness), but there were many drawbacks, most notably its high potential for addiction, its short duration of action, and its effects on the heart and entire cardiovascular system.

In 1905, procaine was synthesized, and it was immediately adopted as a replacement to cocaine. One manufacturer came up with the brand name Novocaine (also called Novocain and misspelled as novacaine ). Due to the marketing efforts of this manufacturer, Novocaine became immediately popular with dentists and it subsequently entered the vocabulary of most Americans.

Lidocaine – the most frequently used dental local anesthetic in the U.S.

Novocaine was widely used in dentistry in the early decades of the 1900s with great success. However, it was noticed that some patients suffered allergic reactions to Novocaine. While some of the allergic reactions were mild, others were more serious (note that people are not allergic to novocaine; people can be allergic to PABA, a direct metabolite of novocaine). As a result, a new class of local anesthetics was developed in the 1940s that did not have the same incidence of allergic reactions. They became commercially available in the 1950s, and then the use of Novocaine began to decline in the 1960s. By the 1980s, nearly all dentists had stopped using Novocaine in the United States, and lidocaine (pictured above) became the most frequently used local anesthetic.

Why this dental myth persists…

One would think that I, as a practicing dentist, would know exactly why this myth has persisted for so long. I am unsure. But here are some ideas:

Many parents indoctrinate their kids with stories (and phobias) about dentistry. If the parents use the term Novocaine, then kids get used to the term too. Many of those kids are now grown up and pass along the “novocaine” myth to their kids.

Procaine (the generic name of Novocaine) is still occasionally used in certain fields in medicine. In addition, other local anesthetics in the same family as novocaine are used in dentistry as topical anesthetics. This might be a reason.

Comments

It’s not puzzling at all. Say’s the dentist in his own myth-busting article “I usually do not correct the patient, unless he/she works in the medical or pharmaceutical field. If I were to answer the question…” How else might a non-medical or non-pharmaceutical person know? A simple “Actually, we almost always use lidocaine now, because…” would have filtered out into common knowledge a long, long time ago if the professionals would have thought it mattered, or if they thought us commoners could actually grasp the idea of a new/better anesthetic.

You are not the first person who has brought this up nor will you be the last. However, if you understand typical dentist/patient interactions that occur on a regular basis, you might see why the myth persists. First, I do not use the word novocaine. If a patient asks me about it, I will explain that we no longer use it. This occurs to me sporadically. What happens more regularly is that a patient mentions novocaine. However, the mention of novocaine is usually in the middle of a dental story that a patient is telling me. Psychologically, this is what many patients do to relieve the stress of being with me (or any dentist for that matter). They tell a story, I listen and show compassion, we joke about it, and then the patient becomes more relaxed. A more relaxed patient leads to a smoother and quicker procedure with less likelihood of complications.

The absolute LAST thing I should do is to interrupt the patient and tell them that novocaine is no longer used. Because what would it accomplish? It would actually antagonize most patients. Believe me – I know – because I did it for a while and actually had patients complain to my staff about it.

So, it is not that “commoners” can’t understand it. All patients could understand it. But my objective as a dentist is to keep my patients as relaxed as possible and do high quality dentistry. And correcting them about this while they’re in the chair is not going accomplish that objective!

In Oct 2013 my dentist injected me with an anesthetic before filling a tooth. Immediately I developed a left sided headache (starting at the occipital lobe radiating to the left ear and left eye). I forgot to mention it when she returned to the room. When I got home, I noted the procedure in my journal. Last month I returned for fillings, mentioned the previous reaction, and requested that a different anesthetic be used. She told me she used novocaine which contains epinephrine and can cause headaches. I told her I’ll inform my PCP that I’m allergic. The dentist used carbocaine instead.

If I had to guess, your dentist was using the term novocaine loosely. Novocaine has not been commercially available in the U.S. since the mid 1980s – and even then it was rarely used.

Based on your description, I would venture to guess that epinephrine entered the bloodstream leading to those symptoms. If this is the case (and I wasn’t there so I can’t be sure), this is often mistaken as an allergy. I wrote about this phenomenon in this MythBuster.

Carbocaine (which is 3% mepivicaine) does not include epinephrine so you should ask for that going forward.

Don,
As you can see by this blog post and the 100+ comments, the term “novocaine” is used by both dentists and patients quite freely. Novocaine has not been available in the U.S. for nearly 30 years. I suspect your dentist is just using the term that most patients are familiar with. After all, if I asked my patients “Are you allergic to septocaine?”, most would look at me and likely say “I don’t know what septocaine is but I’ve had novocaine many times without a problem.” Patients don’t know the names of modern dental local anesthetics – unless they work in the medical or dental field.
But I can assure you, just because your dentist asks you that question, does not mean he/she is going to use novocaine!

Should it be the patients preference on how they should be numbed up? Everytime I go into the dentist they would try to numb me and wait for about 15min. before they get to work on my teeth. Sometimes it’s even a longer wait and in the middle of the drilling I begin to feel pain again. 30 + years ago 5 mins. after I am numbed I don’t feel anything and the dentist can carry on with his work with no problems. Can it be my age, and hypothyroidism that can be the blame?

Doug,
Certainly the patient should have input on how they should be numbed, so long as his/her request is both reasonable and attainable. Keep in mind that some teeth require injections that take longer to exert their effect. In addition, some anesthetics will kick in more quickly. And lastly, there are new developments (like this: http://www.onpharma.com/OnsetApproach.html) where the patient will literally be numb in 1-2 minutes.
Having said that, there are dozens of other factors that affect the efficacy of local anesthetics. Age and thyroid status could play indirect factors. The solution would be to communicate this to your dentist up front, so he/she is prepared.

Hi
When I visited my dentist she seems to have a choice between two anesthetics
I’ve herd her say lidocaine but I do not know what the other one was
when I had a tooth extracted once It hurt and when I went back to see her on the next appointment , I mentioned about the tooth hurting me when it was extracted
and she said I gave you the wrong anesthetic ,because I thought your tooth would come out easy
so jokingly when I have to have a tooth extracted I always say give me the strong stuff
I thought it was novacane ,but it must have been lidocaine
so what other anesthetic could she have given me, and what is the strongest

Garry,
That is an excellent question. I am assuming you live in the United States and this incident occurred within the last 20 years. I can assure you your dentist did not use novocaine.

Lidocaine is the most popular dental anesthetic. There are more powerful ones out there. Sometimes for extractions I use marcaine (generic name is bupivicaine). Marcaine can last a long time – like 8 hours – but it helps to ensure my patients feel nothing during the extraction. Other times I will use septocaine (generic name is articaine). Those are both more powerful than lidocaine. In general, if I am doing a filling, I use lidocaine. But for extractions, I use either the marcaine or septocaine because you need to be more numb for a tooth extraction than for a filling.

In the future, you could always ask for one of those two, or just ask for extra lidocaine. I hope that answers your question.

Dr i had a question, i was given up to 5 shots during a root canal. i think it was lidocaine. it might have been more but this was years ago. the tooth never went numb, infact this is the 3rd time its refused to go numb. after a while the dentist said my nerve was too deep, and i was in alot of pain, so he cleaned the inside with an antiseptic and filled it up.. why wont my tooth go numb? is there anything i can do to help it get numb easier? at this point the shots hurt more than the procedure.

If I had to guess this is probably a lower back tooth? Some teeth in that region are difficult to anesthetize because of the variations in the number of nerves supplying them. For lower back teeth, there can be as many as 5 different nerves supplying them, each one requiring a separate injection in a different location. Besides that, there are other factors, such as hair color (see this page: http://directionsindentistry.net/redheads-dread-dentist-part-2/), anxiety level, presence of an infection, and other variables. One or more of these factors are likely behind your tough tooth. Hope this helps.

Just three-four nights ago I had excruciating pain in my upper and lower left side of my mouth. The main tooth, which had a large cavity that was filled quite some time ago, was the source. The decay got behind the filling and I had a pinpoint exposure. He shot me 5 times with “Novocaine” i guess, 4 in front 1 behind the tooth because they couldnt numb me. Proceded to put a liner and medicated filling in. I’ve had the same procedure done on my lower left (where its also been hurting) but never have I had such intense pain in the days following. What should I do

Drew,
Based upon your description, it sounds like the “medicated filling” and “liner” are very close to the nerve and that the nerve might be irritated. You may need a root canal. I would call your dentist and explain your symptoms. Your dentist may recommend a root canal.

Hi
Thanks for your reply I live in England
when she extracted my tooth she gave me about six injections and I still felt pain
and other times I don’t feel anything so I am assuming now she gave me lidocaine when it hurt
also how long should you Waite before extracting the tooth, my dentist only waits about two minutes and tests to see if it hurts
so next time I have a tooth out I will ask what anesthetic she is using
also is the price of lidocaine cheaper than the other two anesthetics that you have mentioned
because I am on the national heath and don’t pay for my treatment I am wondering if she gives me the cheapest to save money
thanks
by the way I am not a red head

Garry,
I am sorry that you had to feel pain during the procedure. That is not the level of care that any dentist likes to deliver

Besides the actual local anesthetic, there are other factors which affect how numb a patient is:
1. Presence of an infection – a persistent infection changes the chemistry in the area and can make it more difficult to achieve profound numbness.
2. Location – some teeth, most notably lower molars, can have multiple nerves, and sometimes you have to give multiple injections in many different areas to numb each nerve.
3. Patient’s stress – being stressed can heighten your ability to sense pain, causing the patient to need more anesthesia.
4. Other factors such as red hair, certain medical conditions, etc.

Regarding your questions, lidocaine is slightly cheaper, but not my much. Using U.S. currency, a lidocaine shot is perhaps about $.20 less expensive than other types. And for an extraction, I typically wait at least 10 minutes, but usually more.

I would talk to your dentist about this. He/she may be aware of other factors that I am not aware of.

Recently I had a filling done on a lower back tooth. I asked the dentist to give me the anesthetic without epinephrine because I had a bad case of very rapid heart rate and nervousness after one use of the regular drug. He said he would do this but it would wear off in 15-20 minutes, which would have been fine since it only took him about 5 min. to do the filling. However, it took a good 4 hours for the stuff to wear off. Can you tell me why the very big difference in what he said vs. what really happened?
Thanks.

It is common to use a local anesthetic without epinephrine in certain circumstances. In general, for most patients, in my experience local without epinephrine will last about an hour. So why did it last 4 hours in your case? There could be a lot of factors. These could include:

1. Genetics: Some people are born with higher blood levels of the enzyme which breaks down the local anesthetic. You may have genetics where you have less of this enzyme.

2. Location of the injection: if your dentist gets very close to the actual nerve, then the numbing will last longer. Conversely, if the local anesthetic is deposited farther away from the nerve, then the numbing effect will not last as long.

3. Physical activity after the injection: if you engage in a lot of physical activity after the injection, your blood flow to the area will increase, and therefore the local anesthetic will wear off more quickly.

4. Other factors which can include: subtle changes in blood pH, your head position during the procedure, your anxiety (or lack thereof) about the procedure, etc.

If anything, the above should just tell you that we as humans are very complex and no two teeth (nor their owners) are the same! But rest assured, based on your description, it doesn’t look there is anything abnormal going on. But ask your dentist to be sure.

This is exactly what happened to me today Nancy. I hate the anesthetic my dentist uses. He goes to great lengths to shoot me full of it and today the tiny cavity I had filled took approx 15 minutes and the anesthetic he uses numbs the whole side of my jaw and face and ear and took 3 hours wear off. I’d almost rather have the pain. Is there anything, Dr Calcaterra, that you can recommend instead of using a novocaine type anesthetic? I have been with my dentist for 20 years but this whole anesthetic issue is making me want to look around at what other dentists are doing. Any suggestions? And my dentist is very good at what he does. I just don’t understand why I have to have so much anesthetic to the point of numbing the whole side of my face.

Thanks for your comments. For certain areas of the mouth, most notably lower back teeth, the only way to reliably get a tooth numb is to do a nerve block. For a lower back tooth, you have to block a specific nerve (called the inferior alveolar nerve), which just so happens to supply the chin and part of the cheek on that side of the face.

I understand the frustration of being numb for so long. There are certain anesthetics that do not have epinephrine in them that do not last as long. You can ask your dentist if he/she can use them. Those include mepiviciaine as well as prilocaine. Both are structurally related to novocaine.

You also asked about Oraverse. That would decrease the duration of the numbing feeling. But remember – that means ANOTHER INJECTION. I can assure you that your jaw muscles will be sore the next day if you received 2 injections.

Sometimes, for very small fillings, I offer to try without any local anesthesia. About half the time, I am able to do it. It’s a win win situation!

Thank you for your response. It was a very small filling and I feel I should have opted out of novocaine. I will ask my dentist next time. I think because he is also a friend he doesn’t want to take the chance of causing me pain. Probably better communication is in order. Thank you again for your response.

Yesterday, I had an upper wisdom extracted (which had a sharp edge). I informed my dentist that the last time he shot me up I had some heart pains that lead me to have to sit back upright. What I didn’t volunteer was telling him it took all the concentration I had to pray for it to languish. The shots were “pinchy”,too. Enough epinephrine to travel to my lower lip

…And numb that,also. I’ve never been a fan of synthetics.(even though our bodies are made up of approx. 70% synthetic Nitrogen..thanks to German scientists @ Luena)
So, he obviously used another numbing product because he didn’t use as much , he only gave me 2 shots, I barely felt the “pinch” , and was a mild wear-off effect. As opposed to the previous time where there was extreme numbness.
During the extraction I felt the tools more, slight pain while the tooth was being ripped out, but it was all the while more worth the experience than to suffer from the anesthesia.. I don’t envy the guys in the civil war, I know that much.
Lastly, I’d like to say Hi to the NSA for reading all our personal information. Jesus saves!

Vernon,
Upper wisdom teeth usually don’t present issues to get numb. I do lots of extractions, including wisdom teeth, and the patients rarely complain. I am glad your experience with your extraction was not too bad.
Nicholas Calcaterra DDS

Irene,
True -caine allergies are exceedingly rare. Patients can sometimes experience an adverse reaction to lidocaine and perceive it as an allergy. Have you been tested by an allergist?

Dipenhydramine (better known as its brand name Benadryl) can be injected as a local anesthetic. This has been used with moderate success. Dentists do not typically carry this in their offices so you should not assume your dentist has it. For more significant dental work, then sedation may be necessary. But first step is to verify what type of allergy, if any, you have to -caine anesthetics.

I was researching online to try and figure out what happened to me at today’s dental appointment. I have a very bad toothache and found a nearby office opened on Sunday. After some X-rays, it was decided that I would probably need a root canal. I was given a shot of something for pain, and within minutes my body went crazy. I was dizzy, my heartbeat felt faint, my blood pressure was off, my vision was blurred, and I ended up in an ambulance. I’m okay now, just a mild headache, but my vitals are okay. My tooth still hurts, but I am a little nervous to go back. What happened?

Raven,
I wasn’t there to observe you but based solely upon your description, it sounds like you passed out. The technical term is that you likely experienced an episode of vasovagal syncope (http://en.wikipedia.org/wiki/Vasovagal_response). It is also known commonly as fainting. I see episodes like this once over couple of months.

Your dentist should have told you what happened. And certainly, the paramedics in the ambulance should have told you too. Did either of them tell you?

Well THIS explains a lot. As a kid, the last time I had a regular dentist, my dentist used Novocain on me all the time. When I went abroad to England and then to Canada, the dentists there use Novocain. Novocain is not contraindicted in people with High Blood Pressure, hence even though I was diagnosed with HBP in 2003 by my then-doctor in San Francisco, I never had any problems with it from the dentists in England and then Canada, AFTER I was diagnosed with high blood pressure – and in 2005-2006 was still not “on” anything for it because she had not given me anything for it. Novocain is not contraindicted for people with high blood pressure – I’ve done all my research as I go to Johns Hopkins and have gone to law school so I’m used to doing research whenever I’m told something absurd which sounds like malpractice or just plain nonsense by the medical profession. Hell, the medical profession screwing with me was the reason why I went to law school in the first place. No lawyer I could afford would ever take my case.

I’ve been wondering what’s wrong with dentists in this country as they’re all telling me that the anesthetic they use can’t be used on people with high blood pressure. If it IS still Novocain then I have a case for dental malpractice or negligence or just plain incompetence, because they should know better than that or they deserve to have their licenses to practice dentistry revoked. In Canada and England apparently it IS still Novocain that’s used because I’ve NEVER HAD ANY PROBLEMS WITH IT and in fact there they don’t even TAKE your blood pressure before dental procedures unless you SAY you’re allergic to Novocain – which, get this, they ASK YOU first.

I was beginning to wonder why EVERY STATE I go to, the “free” dental clinics all say the same stupid moronic thing. That the anesthesia is contraindicted for not only high blood pressure patients but also reacts badly with Beta-Blockers used to LOWER the damn blood pressure.

Well, off to Mexico or back to Canada I go, then, for dental treatment. Both of which are one HELLA long way to go to get “fixed” from domestic violence, don’t you think??!!

Hi, I had a root canal done today. They gave me two dosages of something and some gel. It’s been almost 7 hours and I still have numbness and no control over my cheek but I can feel my tooth, is this normal?

Michael,
Based upon your description, this is most likely normal. Some commonly used anesthetics (marcaine as an example) can make a patient numb for up to 12 hours. I know that sounds like a lot, but sometimes that is the only way to reliably ensure that a patient will not feel anything during a procedure.

I went to the dentist to have a tooth extracted. He gave me one shot and everything was fine when he started the second shot I had some kind of a reaction. The room was spinning so fast I had to hold on to the arms of the chair or I was sure I would fly out of it. I had to close my eyes so I couldn’t see the room spinning. While I had my eyes shut I realized the chair was moved with my head lower than my heart and heart monitors had been put on my chest. Next I got sick and vomited. The dentist said it was a panic attack but I am not sure that is what it was. I had no fear before I went in and the first shot was fine. Someone mentioned that maybe he hit a nerve and caused the reaction. Now I am afraid to get another shot. Do you think it was a panic attack, the needle hit a nerve or some kind of an allergic reaction?

Janice, I wasn’t there for the incident, so I am basing this upon your description only. It does not look like an allergic reaction because typically that will produce other symptoms such as redness, swelling, rashes or hives, possibly airway issues and difficulty breathing, etc. The fact your dentist arranged the chair so that your head was lower than your heart tells me he/she thought you were fainting. This is technically called vasovagal syncope (https://en.wikipedia.org/wiki/Vasovagal_response). People can get very nervous at the dentist, and I see this periodically. It is unlikely because of what was in the shot; it was more likely based on the concept of the shot as well as about to have a tooth pulled. That is what I think it is, based upon your description alone. Hope that helps!

The exact same thing happened to me. 5 minutes after the shot the room started spinning annd I vomitted for over an hour. My husband had to pick me up and I slept for about 2 hours. As soon as it wore off, I felt better. Our dentist is a good friend and I don’t have anxiety/panic attack issues. I have had numerous dental procedures over the course of my life and have several in the past year. It was clearly a reaction from the injection, not anxiety.

The last 3 dental visits when I needed work done and was given a shot I felt shaky and my heart raced. I wasn’t nervous so it wasn’t from that. It happened after the shot while I was waiting for the complete numbing to occur. Three times! Now I need to go back from a toothache and I am afraid of the shot. I didn’t want to say anything because I thought my dentist would say that I was nervous. What could this be?

Karen,
Based upon your description, it appears that the epinephrine in the local anesthetic is getting into your bloodstream and causing your heart to race (among other things). This is quite common. At your next visit, you should ask your dentist to use a local anesthetic that does not contain epinephrine. Note that the local anesthesia will not last as long, so he/she may need to give you more halfway through the procedure.

I have a question for you…I went to the dentist yesterday morning just for a cavity & still today I have swelling in my cheek & I can hear the liquid moving around when I pressed down on it & I saw liquid move up to my eye. I stopped touching it immediately & went to my dentist but they didn’t have much to say & they told me to give it a few days for the swelling to down. Is this normal? Will it go away? What causes this?
Thank you

Melissa,
This is a tough one to comment on without doing a proper exam. It sounds like there might be an accumulation of fluid in the tissue. While this is not normal, there is always that potential when injecting anything into the body. If this is the case, it should self resolve. But your dentist can probably answer it better, since he/she was there and was able to examine you.

Jonathan,
Astute and concise observation there. That definitely is a factor, but not the only one. Since this post receives so much traffic, maybe I’ll do a follow-up post where I address your point more formally.
Thanks

I just came from the dentist where I got a couple fillings. The dentist called it Novocaine. If he was using something else why would he call it novocaine? I’ll check the records next time I’m there, but that would certainly add to the myth unless it really was what he used.

Nelda,
Novocaine hasn’t been available in the U.S. for over 25 years. Your dentist probably called it novocaine because that is what most patients still identify with. And your last sentence hits the nail on the head: the myth lives on because dentists still call it novocaine (despite no longer using it!)

Recently, I went to see my endodontist for a root canal. I am 58 years old. He did two previous root canals on me in the last 20 years. He sold his practice and is working only 2 or 3 days a week almost next door. They took my blood pressure with a ‘watch’ which had never been done before. I got all stressed out because he told me that I needed to be on high blood pressure medication? I went to see my internal medicine doctor and he said that I did not have to take medication and could go for the root canal. I trust this endodontist since he did two beautiful root canals before without any problem.
What is going on here and how should I handle it? Some one told me that the ‘watch’ to measure the blood pressure is not accurate.

Taking blood pressure at your dentist’s office is not that uncommon. I will frequently do that on patients who are medically complex. If a patient has untreated high blood pressure, a stressful dental procedure can cause an increase in blood pressure, leading to an undesirable consequence.
That being said, wrist style blood pressure monitors are not that accurate. In addition, the stress of being in the dental office can cause a leap in blood pressure (this is called white coat syndrome). However, your endodontist was only looking out for you. He has your overall safety in health in mind.
If your primary care physician evaluated you and said your blood pressure is fine, then you shouldn’t worry about that. Have your primary fax a letter to the endodontist and then get the root canal procedure done.
Hope that helps.

I have been going to a dentist for a couple of years now. I needed a root canal on my back right molar. He gave me 3 shots of Articaine and I had pins and needles going down my arm for about 10minutes which had never happened before. He ignored the reaction and I left with a temporary filing. As I am now going to be 60, I feel afraid of anaesthesia and an allergy test did not show anything except nauseous and sick to my stomach from Lidocaine and Scandonest. Did the dentist damage a nerve as I have pain on the right gum at the back intermittently and not sure why in that area? For the permanent crown will I need a local anesthestic or will nitrous oxide suffice? I have lost trust in my dentist and I am going to a dental clinic at the hospital as I am worried about my age

Doreen,
Your description of your experience doesn’t sound fun. Your description also paints a very complex picture, one so complex that I can’t figure out what really happened. Remember – I wasn’t there to see it! Hopefully the new dentist at the hospital can answer your questions.

I am, I guess you could call me a younger generation patient of the 90s who routinely has gone to the dentist since I was about 4. I had several filings done and my dentist did use novocaine every time. Originally, they just stuck the needle in the gums and numbed to root and nerve to the tooth so you didn’t feel the filing and the sensations of the procedure. Mind you, this was back in the early to mid 90s at a pediatric dentistry.Then, shortly after kids became petrified of going to the dentist to get cavities filled, they began using the topical gum solution that temporarily numbs the site so the shot is less painful, but you still received novocaine, regardless. Now, I’m in my early 20s and need a filing replaced.( the silver mercury ones were all they had then) and I’m so scared of that shot because most adult dentists don’t use a numbing solution before the inject.

Most adult dentists do use topical anesthetic (that is the numbing solution or numbing jelly). If your dentist doesn’t use it, ask for it! Before your appt you should call to ask if they have it. I use it on 100% of my patients – unless they specifically request that I don’t use it. Don’t let fear keep you away. Your problems will only get worse.

Are dental assistants allowed to seat temporary crowns without direct supervision of the dentist? I had this happen recently for the first time. The dentist left the room, and the assistant fitted the temp crown on, jamming it on, and then using a drill to grind off rough spots at the bottom that were protruding. (Before that, she was pulling on it hard, as if she were trying to remove the already cemented temp crown, to where I feared the delicate tooth might break, as she worked she said nothing, contributing to my alarm) I don’t recall any of the other crowns I had, where the assistant did this portion of the work, alone. Is this something new? I am in Hawaii.

Victoria,
That is a very good question. The laws concerning this vary from state to state. Where I practice in Connecticut, assistants are able to seat temporary crowns as long as a dentist is physically present. I do not the laws in Hawaii. This is a more recent trend seen in the past 5 years or so and is based on numerous factors (at least in New England and New York where I am most familiar). I hope that answers your question.

I was told by my uncle Dr Hoff DDS that the original novacaine was extracted from leaches. As you stated novacaine was a manufacturer’s name so I don’t know what it would have been called but the way the story went is that it was noticed that you can’t feel when the leach bites so they farm raised leaches to extract whatever and use it in dental procedures

I finally got my first- and hopefully last- cavity at age 50. I learned the hard way during a minor surgical procedure that injectable lidocaine does not work on me unless it is ‘buffered’. I made an appointment for a filling today and I feel a little panicky just thinking about it. Is my dentist likely to use lidocaine? Have you ever heard of/encountered lidocaine resistant patients? I read an article about lidocaine resistance and it seems to be more common in redheads. I’m not a full-blown redhead, more like a strawberry blonde. :p

The minor surgery I had was my first experience with lidocaine. It had little effect. I felt everything. It was a terrible experience and years later it still haunts me.

A little while later I had a biopsy of a mole by my dermatologist. I was prepared for pain but I felt nothing. :). I asked the nurse if they used lidocaine and she said yes, but it was a buffered solution that they make themselves because some of their patients are lidocaine resistant.

I have since had a liver biopsy (after 50 everything goes wrong ). I requested buffered lidocaine and I felt nothing- not even the doctor pressing my side with his finger to see if the anesthetic was working.

After all this I talked to my sister about it. It turns out she had a terribly painful biopsy and her doctor was baffled. She had used lidocaine so why was my sister in pain? My sister has dark brown hair, btw.

Anyway, I’m glad you’re aware of this. It’s a real problem and not just anxiety about the minor ‘ouch’ of an initial shot of lidocaine. Not even close.

I’m curious about why some specialists routinely prepare buffered lidocaine and others don’t. Maybe some have the equipment you mentioned. Either way, I’m going to call my dentist and ask if he can buffer his lidocaine.

Tami,
Your experiences, although infrequently observed, are not unique. Buffered local anesthetics are relatively new to dentistry. The company marketing the solution to dentists is less than 10 years old. It is unlikely your dentist has this solution. He/she may not even be aware of it. You could always call the company (Onpharma) and find out the closest dentist who has their product.

Note that I have no connection to this company but I have been thinking about purchasing their system for quite some time.

I had a lower molar extracted 18 days ago. It took 3 shots for me to be numbed (the shots were back where my upper and lower jaw meet) and one of the shots was terribly painful in a “hitting something wrong” sort of way. The extraction went fine. After 2 weeks I returned to the dentist with pain in the extraction site only. He saw no bruising or wound and had no suggestions. Another week has passed and I am aware of the injection site at every moment, can taste a metallic taste, and there is pain there off and on. What could be the cause? I am afraid to ever get another injection there.

Kit,
Injections for lower molars can be very painful. That is because the nerve that needs to be anesthetized is under about 1 inch of tough muscle. Penetrating that muscle with a needle can lead to significant post-op pain in the injection site area.
Your story is a bit perplexing. Injection site pain 3 weeks later is not typical. A metallic taste can come from a lot of different things. Without being able to examine you and take a detailed history, there is not much more I can add. But I would recommend seeing the dentist who removed the tooth again.

Thank you so very much for your reply. I have since gone to Urgent Care and they feel that there is infection at the injection site – so they swabbed the site, will culture it – and I am on a new antibiotic. I already feel better….

What type of anesthetic do you recommend for extraction of #19…an anesthetic without epinephrine please. I have MVP and last time a dentist game me the kind with epinephrine I ended up in the ER. I told her to please not to use it because I’ve had issues before but she insisted. Thank you very much in advance.

The anesthetic I typically use that does not contain epinephrine is 3% mepivacaine (brand name carbocaine or polocaine). Some dentists also use 4% prilocaine but I do not find that to be as effective. You have to give extra because without epinephrine, the anesthesia feels less profound and does not last as long. Hope that helps.

Dr. I read in another post that you wrote about injections for the bottom molars being a bit more difficult and have been seen by my dentist today but I’m still confused and thought maybe you could shed some light. One week ago I had #19 and #20 filled. She said that 19 looked bad as far as the root and recommended a root canal. I asked if I could have an extraction instead and a bridge in the future due to finances right now. She said yes. She said because she had to get so close to the nerve I could experience pain later. Because my jaw was open for so long I took ibuprofen later because I have occasional episodes of tmj. For the next 48 hours I took ibuprofen only ever 8 hours. Then it went to 12 hours and even one day so far as 24 hours without meds. Ibuprofen always helps. The pain is not excruciating but mostly reminds me of when my jaw was being held open, she even gave me extra shots when I told her my jaw hurts. Today she took another X-ray and said no infection but looks ‘suspicious’. I asked what that means and she said that an infection could be coming. She seemed doubtful that it was tmj but didn’t totally disregard. The pain goes from the center of my chin and can extend to my ear. I have my appointment for extraction in one week. If I may ask, what are your thoughts on this? Any info at all would be greatly appreciated. I’m concerned that I’m not getting it extracted soon enough. Thank you in advance.

Marnie,
Without being able to examine you and see the x-rays, it is tough to assess whether the pain is coming from the nerve in the tooth or whether it is originating from the joint and/or musculature associated with the TMJ. Both can present with pain similar to what you are describing. As a general rule though, if the pain gets worse with temperature (hot or cold foods/drinks), the it is highly likely it is the tooth and not issues with the joint/muscles. Your dentist sounds like she knows what she is doing so I would rely on her for a definitive opinion.

Thank you so much for your response, it is greatly appreciated. I’m on antibiotic and am definitely getting the extraction. Thank you for your kindness and all of your time for answering my lengthy questions!

On Friday I went to the dentist because I had some pain in the front of my mouth and the tooth next to my top front tooth was loose. I had a cavity in that tooth and was scheduled to get it filled two weeks ago but due to back/sciatic nerve issues I was unable to at that point. The dentist gave me a shot of lidocaine in the front of my mouth and over the next several minutes it started hurting worse then when I came in. So he gave me another shot in the roof of my mouth and again the front, and still lots of pain and it started to radiate to the back of my mouth. My mouth was numb (and so was my nose) but I still had lots of pain. He gave me another shot that felt like it was between the teeth and extremely painful and one in the back of my mouth. I was clenching the chair and had tears (first time I ever cried at the dentist). He decided to do a partial root canal to drain the abscess which gave me relief for about one minute and then back to extreme pain. He gave me another shot which felt like it was in the hole that he had drilled for the drainage. At some point, not sure when, he switched to a stronger injection but I am not sure what it was. After about one and half hours I had lost count as to how many shots he gave me. He finally pulled the tooth and there was instant relief. The assistant counted up the vials and there were nine total. Is this normal? I was taking oxycodone and a muscle relaxer for my back at the time, would this effect it in anyway? How did the abscess get that bad that quickly without feeling pain?

Michelle,
You describe a lot of things. In general, in the presence of an abscess, it is more difficult to achieve profound anesthesia. This is because the abscess changes the chemistry of the tissue around the tooth, making the local anesthetic less effective. Also, a person with an abscess typically has anxiety (and rightly so), which can make them more sensitive. Lastly, chronic use of narcotics such as oxycodone can make people be more sensitive to pain. All of that together is likely why you felt so much pain. 9 vials is a lot for one area but not totally unheard of. An abscess can be chronic at one point and then become very acute and painful very rapidly. Overall, that is still an unfortunate situation and it is too bad you had to experience it. Good thing you are out of pain now!

Yesterday I had a filling done on my bottom lower molar (farthest tooth back). It took approximately 3 hours for the numbing agent (not quite sure what the dentist used) to wear off. After it wore off, I noticed my ear started to hurt and feel like there was water pouring out of it. I tried to sleep, but the pain was just too intense. I took 800mg Ibuprofen and still, no relief. This morning I woke up and I feel light headed, dizzy, intense inner ear pain, throbbing, and swelling. Could this be a result from the numbing agent they used? I feel like I can barely function, my ear hurts SO bad. I made an appointment with my primary care doctor before I thought that maybe the ear pain would be related to my dentist visit. I spoke with my dentist and he said he needed to see me immediately. What could be going on? I am freaking out!

Sara,
Based on your symptoms, it sounds like it is most likely pain from the injection. To numb a lower back tooth, the needle goes in quite deep – approximately 1 inch – and often that area can hurt for a couple of days afterwards. Pain can radiate to the ear. But you are correct to see your dentist who can determine definitely what is going on.

I had a root canal on 19 and an inlay on 3 I’ve been back now a 3rd time for the Permenet crown on 19. The lab keeps missing the margin. Is this normal. Also the dentist missed a root canal on 3 instead performed a inlay soon after the permenant crown was seated I began having serious pain in that tooth. An endondontis performed a 4 root canal thru the permenant crow. As it turns out that crown needs to come out because interior to the crown between 2&3 food particles keep getting stuck. Is this all above normal or should I run like hell and find another dentist

Jerry,
What you are describing happens to all dentists every now and then. The human body is unpredictable and unexpected things come up. However, I stress “every now and then” because if those issues are happening on a consistent basis, then the dentist probably is not doing as a good a job as he/she could. Without more clinical data, I can’t offer more details. It is too bad you are experiencing such poor outcomes. Hopefully things work out in the near future.

Sharon,
You bring up a very interesting point.
Earlier in my career, I used to correct people. I did it very diplomatically. For the majority of patients, I would see two types of responses:
1. They would perceive me as being cocky and arrogant, despite me being very diplomatic and nonchalant in my correction.
2. They would continue to insist that novocaine was being used despite my explanation. And if I pressed the issue, they would perceive me as being cocky and arrogant.
After a while, it was clear to me that by attempting to correct patients, it was detrimental to the patient-dentist relationship, and I stopped.
If you were in my chair Sharon I would be happy to talk with you about the history of local anesthetics and how each one works… assuming you wanted to hear my explanation! Thanks for the candid feedback.

Excellent comment, Dr.! I do believe most of us wish we could have such a kind, diplomatic dentist that is more than willing to educate!! I’ve always said ‘novocaine’ just as I’ve always said ‘Kleenex’ instead of tissue! In my opinion, it’s just a name like so many other brand names that we’ve clung to and as long as the dentist knows the difference…lol…than that’s all that truly matters!!

First, thank you for taking the time out to educate us and answer our questions. I personally appreciate you input.

My question is I went to the dentist and I got 2 filling done on the same side (upper right). This was done 48 hours ago and when I press my cheek it is still sensitive where I was injected. Is this normal? My local numbing agent did last a few hours as well.

Hello Doctor,
I need your advice/opinion once again. I recently had #19 removed and soon after it was removed I noticed #18 looks awful. It has much decay and a very big amalgam filling. The original thought was to have a bridge after #19 was taken, but now by the looks of it ill have to have #18 removed as well. I don’t know why my dentist wouldn’t have noticed that it was so bad, but I was wondering the most reasonable ways to correct the gaps that will be left from those teeth. A bridge wouldn’t be possible any more would it?

Marnie,
I am assuming you don’t have #17 (your lower left wisdom tooth). If that is the case, a bridge would not be possible, because a bridge requires teeth on both ends for support. Your only option after #18 is gone would either be for dental implants or a removable partial denture.

There is no mystery as to why people call it novocaine. Its just a brand-shorthand like Kleenex for tissues or the verb “to Hoover” for vacuuming. But it does make it seem like there is only one type of local anesthetic used and that is a problem. Now that I’ve read these posts, I will ask my dentist exactly what she uses on me and maybe participate a little more in the process. I would prefer a lighter one for small fillings, for example, since I am still sitting here at home 5 hours after the procedure and unable to eat – well at least to taste and chew.

Prisca,
You are the first person to make that particular observation. And I do believe this is one of the MANY reasons why people still think novocaine is still used. This particular blog post gets over 200 hits a day which just shows you how ingrained the term “novocaine” is. Thank you for your comments.

I asked my dentist to use an epinephrine free anesthetic because I do not react well when I am given this. (Racing heart, shakes etc.) However…on my last visit he assured me that he did not use it yet… Yet I shook and convulsed uncontrollably within about one minute after being injected. It was super scary and was by far the worst reaction I have ever had to any injection. ( It sure felt as though it had epinephrine in it. ) My question to you is…is it possible to react this way without the epi in the anesthetic
?

Tracy,
It is certainly possible but less likely. I’ve seen patients react in the way you’re describing out of fear. Just the thought of an injection causes them to react this way. So it could be purely psychosomatic. Alternatively, one of the common local anesthetics is lidocaine which is also used in certain applications to adjust the rhythm of the heart. There is the possibility that some of the local anesthetic went into the bloodstream and traveled towards the heart where it exerted an effect. Possible, but less likely. I am more inclined to believe it is psychosomatic. Hope this helps.

How long has epinephrine been in use in lidocaine? I ask because I had a couple fillings, a crown and a root canal (and crown) done on my teeth more than 5 years ago, I recently have had some work done (another crown, and in the process of a difficult root canal – instrument got stuck and sent to a specialist – Dr. West) and I notice both my Dentist and the specialist use epinephrine, which was a surprise to me, as it’s the first time in my life I’ve experienced this. I asked if the drug/formula was new, and the assistant seemed to think it was an odd question. I have recently moved from the Midwest to the Northwest so perhaps its a regional thing?

Daniel, the use of epinephrine with lidocaine is definitely not a regional thing. Most dental anesthetics have come with epinephrine for years. The epinephrine makes a big impact on both the duration and the profoundness of the anesthesia. There are some dental anesthetics that come without – but they are primarily used in those patients with heart conditions.

Dr. Jason West treated me the first time. Dr. Jordan West treated me another time. I haven’t been treated by Dr. John West though. The Doctor that referred me said that they were internationally famous in the Dental community, so I thought that was cool. Small world indeed!

Interesting to know about the epinephrine though. Maybe it’s an age thing for me, not noticing it until now. I was much more fit and 6 or so years younger so maybe I just didn’t notice the heart racing thing and attributed it entirely to nervousness and summarily forgot about it. I definately noticed it this time, but nothing major – no reactions other than very fast heart rate.

Whether you feel your heart racing also depends upon the site of the injection. Some areas of the oral cavity have larger blood vessels that can carry the epinephrine towards the heart and other organs.

I had a root canal performed where the DDS gave me 7 shots over the course of the procedure. After it was done (which incidentally had to be redone by another DDS 1 year later since he didn’t get all of the root), I went to the men’s room and had bright red blood in my urine. Have you ever heard of this side effect from anesthesia?

Andy,
Your story sounds alarming. I truly wonder if the presence of blood in the urine is/was related to the administration of the local anesthetic. I would consult with your physician on this, as blood in the urine can potentially indicate serious issues completely unrelated to the local anesthetic and/or the root canal procedure.

Thanks for the fast reply doctor. I too was very concerned when I saw the blood in my urine. I had a complete exam by a urologist including CT scan, with and without dye, ultra sound and a scope of my bladder, all of which were fine. That’s why I was wondering if you had ever heard of blood in the urine from anything related to dentistry?

Hi Dr,
I am about 6 weeks pregnant and also have a broken (and very painful) tooth. It is the very back tooth on my upper left side. I have an OB appt in 13 days. My OB is only in my local office two days per week and is completely booked for a sooner appt. The dentist is refusing to touch me without a release and my OB office will not give me a release until my appt because I’m not technically a patient yet. I cant go to a different OB because it is the only one that takes my insurance. My question is: If I go to a different dentist and not tell them about my pregnancy so I can have this tooth pulled, is there any danger in that? I cant take this pain anymore and I’m scared of getting an infection. I have been told by many people that they had dental work done while pregnant. Help!

Ashley,
It looks like you’re in a tight spot. But there is no way I can advise you to withhold information about your pregnancy from another dentist. I treat pregnant patients all the time, including extracting teeth in cases of pain and infection, but I always require a release from the OB. I wish I could tell you otherwise but I can’t. Sorry.

Antonio, sorry for taking so long to respond. Anesthesia that has not worn off after 4 days is not normal. This could mean something else is going on. I would call your dentist soon to have him/her evaluate you.

Hello Doc,
I have a question that I’m pretty confused about. I have a tooth that had a root canal and crown about 20 years ago and I notice it has a dark blue line around the gum line of this tooth. Would could this mean?

Mamie,
That is most likely normal but without examining your I can’t be sure. But after a root canal, the tooth can slowly turn a gray/blue color. This is very common. So that is what is most likely occurring.

Thanks as always doc. Just had a root canal in tooth 20. No problems whatsoever until I discovered I can’t open my mouth very far. Have a history of tmj but nothing too major as I only have problems maybe once a year. Doc prescribed me steroids but I hate taking medicine. Also advised to do warm compresses and mouth exercises. I do the exercises and compresses. There isn’t much pain just can’t open my mouth like normal. Any suggestions? Wondering if this will go away on its own. Thank you.

I have had several crowns done over the last 10 years and seem to have some sort of reaction to the shots each time. I always get a canker sore at the injection sight. I usually get a sinus cold and my cheek hurts when the shot in in the upper jaw. Could this be an allergy to the injection and should I ask for something to go with the shot or a specific type of numbing drug? I do have HBP, have a history of sinus issues and am 60 years old.
Thank you.

Eileen,
That is a tough question to answer without examining you. Your dentist could give you a more thorough answer. However, some people do get sore spots that resemble canker sores at injection sites. That is from the trauma of the needle and is not a sign of an allergic reaction.

I have had 2 2 hour sessions for root canal on far back lower molar. I had to have a great many shots to numb the area. Before each session, I took .50 mg of xanax. After each session, I was extremely tired, even after a great deal of sleep. The feeling of fatigue did not clear until the next day. Could the shots have caused this?

Laurie,
Based on your description, that is most likely the Xanax! The half life is 11 hours, which means the xanax has an effect on most people for approximately 24 hours, depending upon how you metabolize the medication.

I am now 26 but since I was 18 my dentist wanted my wisdom teeth pulled out. This time last year I finally saw a specialist to talk about the procedure. After he told me all of the possibilities of what could go wrong he told me he was going to use novacaine. I was so taken back that I said ” novacaine?” And started laughing. I guess he was serious because he looked confused/annoyed. I never went back and cancelled the operation.
That’s the only place that accepts my insurance to have my teeth pulled so what do I do now? One of my wisdom is starting to periodically hurt.

Sabrina,
Some dentists continue to use the term novocaine even though it hasn’t been used since the 1960s. Some dentists use it the way you might use “kleenex” or “scotch tape”. Most tissues are not kleenex, but many people still use the term since everyone is so familiar with it. So I doubt your dentist was going to use it. Regarding your insurance, that is a limitation a lot of people run into, and I don’t have any solutions for it.

Every time I have dental work done and the dentist gives me the numbing agent shots, my heart races for a minute or so. I recently found out that I have an allergy to benzocaine. Are all of the “caines” related and could that be why I have the racing heart? I’m kind of worried and dreading the next time that I need dental work done.

Kathleen,
Benzocaine is most often used as a topical anesthetic (the numbing jelly). The anesthetic that is injected in the U.S. these days is a different family then benzocaine. With respect to your heart racing, that is most likely from the epinephrine in the anesthetic. I described this in another MythBuster located at: http://directionsindentistry.net/dental-mythbuster-allergic-epinephrine-allergy/

I had a root canal done about three weeks ago, and the tooth prep and temporary crown done last Tuesday (this was a tooth that had a crown, where decay had gotten in because the tooth cracked – they put a temporary crown on with permanent cement after the first visit where he removed the old crown and the decay. The root canal guy drilled through the temp crown). I’d never been to the root canal guy before, and despite being a nervous wreck it went well. The procedure was late afternoon, and that night I woke out of a dead sleep feeling like I was having some kind of drug withdrawal. Was nervous, restless – not in pain, but not right. Could he have been using something other than what my dentist usually does? I’ve never had that kind of reaction before. It was a back molar so lots of shots. On Tues when they did the temp prep everything went fine – lots of shots again though. Now one of the injection sites is really sore. Not the tooth, the cheek area behind the tooth. When I look at it in a mirror there’s a little white line there and it looks a little red. It’s not super painful, but is this normal? Hasn’t happened to me before and I’ve had lots of shots.

Finally, is there something that can help me get through these procedures without being traumatized? My dentist doesn’t want me to use nitrous. I’ve been trying to self medicate with a nice bottle of chardonnay, but that’s kind of a waste and doesn’t really work! I seriously feel ill for a couple days after these long procedures and know it’s from being balled up like a fist and panicked for that long.

Jennifer,
Pain at the injection site is common and nearly always goes away within a couple of days. The white line could be a lot of things, but based on the location, it is likely from biting your cheek. I posted some photos of typical examples on my main website if you want to take a look: http://www.orangectdentist.com/dental-library/cheek-biting/

I will often prescribe a light dose of a benzodiazepine for patients who are anxious/nervous. This family includes Ativan, Valium, and Xanax. You should call your dentist. He/she should not have a problem calling in a prescription for you.

I found this site because I did just get a novicane injection for 2 cavities I had filled. I have only had one other cavity when I was young and at that time a local anesthetic was used. This time they used a needle and injected it in several places. I started having a hard time swallowing and noticed I was starting to feel very numb on the whole left side of my head, down my throat even. I let him know and he apologized and said maybe he had used too much. When I left the office I felt like my balance was off and I tripped and fell in the parking lot scraping my knee. I only life 2 minutes away but honestly thought (should I drive?) No I didn’t get any kind of gas, just these injections. Now I feel sick to my stomach, I feel confused, and I realize my equilibrium is off probably because my left ear is totally numb as well. I am concerned. I seem to be affected by any kind of “numbing” agent. I have been given gas twice for different procedures in my life and both times there were complications and Dr’s were surprised by how much it affected me. I am a 33 year old female 5’6 140lbs. Any thoughts on this?!

Sorry not a novicane injection but a lidocane injection or whatever it is. I just know it was injected He also told me whatever he used was a kind that “wears off fast” and it’s been 4 hours and it’s still very very numb!

I had tooth #3 pulled 3 days ago and had a lot of issues getting numb. The oral surgeon had to keep stopping and give me more injections (a total of 10) before it was completely numb. I don’t usually have such an issue, and strangely actually look forward to local anesthetic on that side. I have trigeminal neuralgia that gets especially bad when I have a bad tooth triggering it which is only completely relieved when injected with anesthetic. However, even though my face is no longer numb on that side, I can’t move my upper lip. It doesn’t seem to just be sore or swollen affecting the movement, I actually cannot move it up at all or smile. Is this normal after 3 days or could a nerve have been damaged from the injections?

Hi, great article! just a question or two for you. Today I had 3 teeth extracted #30-32 they used lidocaine and it had to be the most pain i have ever experienced, they had to stick a bite block on the opposite side to keep me from biting down when clenching. But what i find odd was a had 2 teeth extracted not too long before that and didn’t really feel a thing. It was 2 different places for the extractions, so basically i was wondering if you had any idea what the other dentist may have used to numb me up? I will be going back to the dentist (dental school) to have all my teeth extracted sometime next month and would like to avoid that pain if possible. when i say pain i really mean pain, i felt numb didnt feel them cut the gums or anything but when they went to dig the teeth out it was almost like i had never been numb’d to begin with.

Jack,
Your experience is less likely due to the choice of local anesthetic and more likely due to inexperience. Lower back teeth are the most difficult to anesthetize even for experienced dentists. If your treatment is being done in a dental school, the students have far less experience. Unless you are having more lower back teeth extracted, this probably won’t happen again. But certainly you should stop the procedure and ask for more local from the supervising dentist if you feel something.

Well that’s the thing, the supervising dentist was the one that actually did the extractions and most of the local anesthetic. They used a lot too but it was almost like it didn’t do what it was intended too. I’m sure you’ve been numb’d up before and well the whole side of your face goes numb but that wasn’t the case, teeth, gums and everything were numb but the side of my face didn’t get numb like usual (missed the nerve perhaps?) i didn’t feel them cut the gums or anything until they started to pull the tooth. And i will actually be going back in a few weeks to have the rest of my teeth extracted. Just trying to avoid this happening next time! Thank you for the feedback i really appreciate it.

Hi Dr, I live in the US. And I have a question. I have be testing by an Allergy Dr to see if am allergic to Sepocaine (Articiane)Citanest (Prilocaine). And my allergy test came out positive for all with systemic symptoms. Now the question is?? Is there any thing else to use?

Robin,
It seems like you are one of the very few people who have a TRUE -caine allergy. Benadryl has been used with moderate success as a local anesthetic. Here are two links where you can read about it:http://www.ncbi.nlm.nih.gov/pubmed/2625521http://www.drmalamed.com/downloads/files/benadryl_la.pdf
Most dentists are not prepared to administer it in this way. So don’t assume your dentist will have it. You would likely need to call one or more offices. Just be sure to tell them you were tested by an allergist so the office knows it is a true allergy.
The only other option that I am aware of is general anesthesia. But that has issues (and expenses) that must be considered.
Hope this helps.

I have mild temperature and pressure sensitivity in one of my lower molars… my dentist suspects it is a cracked tooth underneath a filling… I’m a brass musician, and the procedure is scheduled for the same day as a dress rehearsal for an upcoming concert.

I am concerned that a procedure at 2:30 will not leave me in any condition to play at 7:30… should I reschedule? I am not in significant discomfort.

Adam,
I would strongly advise that you re-schedule. Numbing a lower molar for that type of procedure will make your lower lip on the affected side numb. And a cracked tooth underneath a filling can sometimes turn into a root canal. Best to do it another time, in my opinion.

I went to the dentist this morning and I musta forgot to eat so he had numed the left side of my cheek and he lowered the chair very low and then all of a sudden I got very dizzy and the whole room started to spin I got very nauseous and started to throw up. what could have caused this? This has never happened to me before and now I’m scared to go back to the dentist can you please help me

Denise,
There could be a lot of explanations for what happened, but I can’t know for sure without taking a detailed medical history and witnessing the event. However, the two most plausible explanations are either acute hypoglycemia from not eating that morning or a vaso-vagal type reaction. I would recommended calling your dentist and getting his advice.

I was wondering if the anesthetic that is used for a tooth extraction should make your heart race. Whenever I have dental work done and I am numbed it makes my heart race at first. This begins to terrify me so badly I am scared to go. I have anxiety disorders but no known heart problems. Is this a normal reaction?

Hi –
I had my root canal done in my upper left No.2 incisor. The canal was left empty so that infection could drain out. The pain subsided within a day of this treatment, although I did not finish the entire antibacterial capsules, as prescribed. I only had six, and I stopped(my mistake).

It was great past three weeks – but since yesterday, the tooth has started paining again. More so when I tap it inward from the outside of the mouth, and worse when I tap it upward into the gum. I can feel my pulse in that tooth(although the pulp was taken out in the RC treatment) and I can also see that the tooth is shaky – I can literally push & pull it inward & outward. Its moving, and weak. I can’t chew anything on my left side. Its not sensitive to cold or hot food/water anymore(maybe because the pulp was taken out already?), but it really hurts upon applying mechanical force (tapping on it, chewing, etc.).

Anuj,
Based on your description, it sounds like the tooth has become re-infected, and there is inflammation present. This is why the tooth is mobile. Is there a reason you skipped the second visit? You should go back and have the canal space filled. Otherwise, you may lose the tooth.

I had a root canal on my upper left 1st molar a few years ago and the dentist actually called the shot he gave me Novocaine!
I’m really confused by this now because I was looking for a dentist that doesn’t use whatever it actually was because my body metabolizes it too quickly for it to be effective.
That dentist was terrible anyway, he missed part of the nerve and the crown he put in is too large in comparison to my other teeth and really puts a lot of pressure on the tooth below it.

R.J.
If you live in the U.S., there is no way the dentist used novocaine, as it has been impossible to purchase novocaine in the U.S. since 1996. Your dentist most likely used the term novocaine as a generic term (similar to when someone uses the word Kleenex to refer to tissues).
There are anesthetics that last much longer. One of them is marcaine. You could always ask your dentist (or your new dentist?) if he/she could use that in the future.

I was born in 1967 and my first dentist never gave me a shot for fillings. The drilling hurt at times but I took it fine. When I was a young adult in 1989 a young guy took his place and told me just because I never had a shot in the past doesn’t mean I shouldn’t have one now but I still said I don’t need one. I took the drilling fine as always. But I’m wondering if there are times when I should let my dentist give me a shot for a filling. The cavities I’ve had filled so far were on the biting surfaces of my middle side teeth (upper and lower) , and one on the side of a middle side tooth (lower jaw). Are back teeth a whole other level of pain? Is the size of the drill bit a factor?

Barry,
The biggest factor is the size of the area of decay. The deeper and or larger the decay, the more likely you will feel it, and the more intense the sensation will be. The drill bit size is a factor, but that is mostly a function of the size of the decay. If a patient has a large area of decay, I will use a larger bur (bur is the technical term for a drill bit) – and the patient is more likely to feel it. In general, back teeth are larger and thus there is more “insulation” between the outer surface of the tooth and the nerve.
I’ve had many patients like you. In general, for a small to medium size area of decay, we can do without any local. But if it is going to be deep, I usually convince the patient to receive local. Hope this answers your question.

I am a white male, now 94 years old. I have had the best of dental care (frequent exams, implants from associates of the Swedish inventor, etc.) all my life. A couple of years ago I started to be troubled by mild pain in the gum at the lower left jaw (exact location seemed to be third molar–wisdom tooth). It would start almost unnoticebly, then get worse for a couple of weeks, then gradually go away. A month or two, it was back again. My regular dentist checked old and recent x-rays but could find nothing. My other dentist (gum specialist who put in the implants) similarly examined me but could spot nothing. They suggested I consult with a well-known oral surgeon at Columbia’s medical school uptown. He used imaging machines I had had never seen but could find no cause. I later consulted a head-and-neck surgeon who arranged for several MRIs which also revealed nothing.

Finally the oral surgeon suggested I have the wisdom tooth extracted. He said I don’t really need it and it might cause trouble (perhaps even what I was experiencing. I had that done with the result that MAYBE there is a little less pain.

Now I see on the Internet that aspirin can cause gum pain. I take an 81-mg tablet daily (prescribed because of a bad family history of heart attacks, some leading to an early death). So I wonder if the aspirin is the cause. Continuing to think about my pain, I have just remembered that a few years ago my regular dentist had me switch from my regular manual toothbrush

I recently went to a dentist in South Korea after 2 weeks of pain in my lower case molar. I was told I needed root canal but after the first trip the dentist removed the old filling and medicated the tooth. However this has been 4 days ago and the tooth is still rather painful with the gum quite swollen also. I am due to return in 4 days time but am very nervous as during my first trip, the pain I experienced although not too intense was apparently minor in regards to my next visit when the dentist will perform the actual root canal treatment. Is there anything I can do or ask the dentist for?

Shirley, based on your description, it is possible your dentist began the root canal when he “medicated the tooth.” But maybe not. It also sounds like you possibly experienced pain during that first visit? If so, there is nothing wrong with asking for more local anesthetic. When I do a root canal on a lower molar, in nearly all cases I give 3 injections, since you need to be very numb for a root canal. That basically eliminates the possiblity of a patient feeling something, except in very rare circumstances. I hope this helps.

Many thanks for your reply. I will be sure and ask for more local anesthetic, although here in South Korea I am of the belief the Korean peoples pain threshold is stronger than mine as they don’t administer too much pain medication in both hospitals and dental clinics! Thanks again.

I am 30 yrs Just had a Root canal. First one ever. I have had 8 cavities before so I am used to being numbed up and all that.
I have a white / greenish Sore in the inside gum near the tooth where the injections went. Had about 6 shots total or so. I figure this is from the irritation. I do have a history of canker sores inside the mouth from time to time.

Joe,
Thanks for stopping by. Six injections can sometimes be necessary for a root canal – some teeth are tough to get numb. Those 6 injections can lead to a superficial ulceration which can appear the way you describe. That is most likely what you have based on your description. But remember, I am not there to examine you so I can’t know for sure. If it resolves within a couple of days then that is likely what you’re experiencing. It could also be a canker sore (real name is aphthous ulcer). Hope that helps.

Being numb 24 hours after a procedure is not normal unless your metabolism is VERY slow. You should check in with your dentist ASAP if you are still numb. When I used marcaine, the maximum amount of time I typically see is 12 hours.

I recently had my first fillings a couple of days ago. I had two cavities filled: one on my right upper jaw and one on my left lower jaw. I just noticed that I have a raised, white line on both sides of my cheeks that are a little irritating. I have also developed sores at the sites of injection. I randomly get canker sores but these sores do not seem to be canker sores, however, they are just as painful and it hurts to eat. Is it possible that I am allergic to the shot and what is causing this white line on the sides of my cheeks?

Natalia,
It is natural to be a little sore at the injection site. Imagine if I gave you a local anesthetic injection in your arm muscle – you would definitely be sore the next couple of days.
The white lines are most likely what are called linea alba. They are from biting the inside of your cheek. Here is a page with photos:http://www.orangectdentist.com/dental-library/cheek-biting/
Allergic reactions to local anesthetics are extremely rare. Based on your symptoms, it is extremely unlikely that occurred.

What local anesthetic is available that is not in the Lidocaine/Marcaine family? I just recently had a dental exam and was told I need a crown. I have had fillings and crowns in the past but now have had an allergic reaction to Lidocaine and Marcaine, identified by a dermatologist. (No antibiotic ointment, peroxide, latex band-aid. Everything excluded) Only Lidocaine or Marcaine had been used. Red swelling itching that did not go away until the area was injected with steroid. I have seen 2 allergist … no help. Interesting though one Dr requested I get Novocaine without epinephrine from the dentist so he could conduct a skin test. Something about Esters and Novocaine. The dentists gave me
2 little vials and off to the allergist. Of course, the allergists said it was not Novocaine. Neither the dentists nor the allergist seem to be aware of the inability to find, order or purchase Novocaine for inject. I’ve been on a search from multiple pharmacies, medical insurance hot line to the internet. I’ve been told no one is allergic to Lidocaine and was in the operating room twice (lower back and ACL replacement) when the anesthesiologist was going to inject Lidocaine until I stopped them. … yes it was on the allergy list. Neither knew anything else to give. Are there other options?

People call it Novocaine for the same reason they reach for a Kleenex when they have to sneeze, put a Band-Aid on a cut, take an Asprin for a headache, and Xerox handouts before a meeting. Brands become so popular and used commonplace they actually become generic terms.

I have charcot marie tooth disease which is a peripheral neuropathy, neuromuscular disease. I need to get a wisdom tooth removed. Is there a different type of numbing medication for local anesthesia that can be used that would be safer for this medical condition? Thank you for your help.

Hi RainyCarter,
The disease that you have is complex and I will be the first to tell you that I’ve never treated a patient with it. However, if you have received local anesthesia at the dentist before without any problems, then getting properly numb for a wisdom tooth extraction should not prove to be an issue. Given your concern over this, I would recommend you see an oral surgeon. An oral surgeon has much more extensive medical training than a general dentist and he/she will be able to do the procedure with sedation and/or other medications if necessary. Hope this helps.

Hi Dr! I went to the dentist yesterday and when I got my shot of local anesthetics, the pain sent me through the roof! I hadn’t had cavities in a long time, but I never remember feeling more than a little pinch during the shot. It felt like the dentist kept shoving it deeper and deeper and it was terrible! I literally almost cried. Do you know why this happened? Should it hurt that badly?

Nicole,
Some areas of the mouth require different types of injections. In some areas, it is easy to make the injection painless. In other areas, it is practically impossible for the shot to not hurt. If I had to guess, your dentist was likely numbing a lower back tooth. This requires what is called an inferior alveolar nerve block; and this is difficult to make it so it doesn’t hurt.
Of course, there are other factors, including whether your dentist is using topical anesthetic, the temperature of the anesthetic, the type, and other factors.

I got some dental work yesterday and they used numbing liquid before they gave me several syringes full of numbing liquid. I recieved no anestetic other than that. The dentist said she noticed I went extremely pale so she checked my blood pressure and found it to be extremely low. What would cause this…fear?

James,
What you are describing sounds like a classic episode of vasovagal syncope. Since most people don’t know this term, it simplistically means “fainting or nearly fainting from a stressful situation”. And yes, this most likely happened due to fear. You are probably the 20th comment on this site about this phenomenon – which means I should blog about it! Until then, you can read the wikipedia entry here: http://en.wikipedia.org/wiki/Vasovagal_response

I’ve been having my silver/Mercury fillings removed. Upper right, then upper left, today, just the injection of the numbing agent, and my throat went numb, and when they reclined the chair, I couldn’t breathe! Not sure if that was just anxiety, or what happened, but, I refused to allow them to DO the lower removal, and 3 hrs. later I am still numb, swallowing makes me think I can’t breathe. Should I go to the ER, and is there anything to help this wear off, as my face and ear are also still numb! I told them, even my chest was feeling the effects. I had a HUGE Para Thyroid tumor removed 22 months ago, and didn’t have my throat numb like this, so I’m almost in a panic. Could my body not be handling these numbing medications? Or did he hit a nerve wrong?

Joni,
It is likely by now that the all the numbing effects have worn off. What most likely happened is a bit of anxiety along with some of the local anesthetic inadvertently making its way into the bloodstream. If you are still numb then you should definitely contact your dentist.

Went to the dentist for a filling with injected anesthesia and returned the next day for another filling and when they started to inject the Lidocaine? the room started swirling, i was trying to hold on to the arms of the chair. My clothes were soaked in perspiration, I felt terrible and then I began vomiting again and again. The room spinning lasted 2 hours. About 20 minutes to 30 minutes into the episode my blood pressure (which I normally run on the low side) was 147 over I think 90. 2? days later I noticed white pimples in that area of the gum. I have been going to this dental office for 36 years. I am 60. It was a newly hired dentist at the office. What are the possible causes?

Maria,
It is hard to know what really happened since I wasn’t there to observe it and gather data. However, one of the most common occurrences that can occur in the dental office is when anesthetic gets into your bloodstream which makes the patient nervous which then results into an episode of vasovagal syncope. Your description most likely matches that – but again I wasn’t there. Regarding the “pimples” near the gum, there could be lots of reasons for that. But as long as they resolve within a week, whatever the cause, there are likely no long term consequences.

Does high blood pressure accompany vasovagal syncope? My normal blood pressure is low and it was 147 over I believe 90+ when they took it at the dentist about 15 minutes into the occurrence. Thank you for responding.

Maria,
Vasovagal syncope is accompanied by extremely low blood pressure. That generally precedes the point at which you faint. Your BP 15 minutes after the initial onset could be almost anything as your cardiovascular system tries to get back to normal. Again, I was not there, so this is pure speculation on my part.

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[…] out, it’s a pretty common misperception that novocaine is still at large in dentist offices. As Nicholas Calcaterra, DDS, explains, what the hygienist actually use on me was lidocaine, which has no known anti-aging benefits. And I […]

[…] “This shouldn’t be too bad.” The dental assistant said as she put a bib on me while the dentist prepared his first syringe full of whatever they use to numb you these days. I was yelled at by a dentist, a “friend” not my personal dentist, when I called it Novocain. Apparently Novocain went out with Tab Cola and non-cable television. For more on that, read this. […]

[…] In 1905, a new local anesthetic, Procaine, was introduced. Procaine had all the desired effects of cocaine as a local anesthetic, but did not posses the addictive potential nor the other negative side effects. Procaine then quickly replaced cocaine as the local anesthetic of choice in dentistry. One company then made the fateful decision to market procaine under a new brand name: Novocain. From that point on, the name Novocaine has become synonymous with “the shot you get at the dentist”, a phenomenon I documented in this Dental MythBuster post. […]

[…] Dental MythBuster #4: Dentists Still Use Novocaine in Shots – Dental MythBuster #4: Many Americans still believe dentists inject Novocaine to work on teeth even though it was discontinued in the U.S. many years ago…. […]

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